N. Lal Mahammed et al. Int. Res. J. Pharm. 2013, 4 (12) INTERNATIONAL RESEARCH JOURNAL OF PHARMACY

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1 INTERNATIONAL RESEARCH JOURNAL OF PHARMACY ISSN Research Article EFFECT OF TELMISARTAN AND RUTIN IN ALCOHOL PLUS HIGH FRUCTOSE DIET INDUCED METABOLIC DYSFUNCTION IN RATS N. Lal Mahammed 1 *, P. Sireesha 2, E. Supraja 3, B. Pooja 3 1 Department of Pharmacology, KLR Pharmacy College, Paloncha, Andhrapradesh, India 2 Department of Pharmaceutics, Sri Lakshmi Venkateswara Institute of Pharmaceutical Sciences, Prodattur, Andhrapradesh, India 3 Department of Pharmacology, SIMS College of Pharmacy, Guntur, Andhrapradesh, India *Corresponding Author rahultej245@gmail.com Article Received on: 28/10/13 Revised on: 30/11/13 Approved for publication: 26/12/13 DOI: / ABSTRACT The objective of the study was to investigate the effect of telmisartan and rutin in High Fructose Diet plus alcohol induced metabolic syndrome in rats. Our study demonstrated the beneficial effects of telmisartan and rutin on both abnormal metabolic characters and vascular dysfunction in insulin resistant rats. Initially we have validated the pre diabetic metabolic syndrome rat model by feeding high fructose diet to the male Sprague Dawley rats. Development of metabolic syndrome and glucose intolerance was assessed by performing the plasma biochemical analysis such as plasma glucose, triglyceride, insulin and total cholesterol levels. Glucose intolerance was assessed by performing an intra peritoneal glucose tolerance test and Histopathological studies of Liver were conducted. In the present study, we examined the effect telmisartan and rutin and the relationship between the plasma adiponectin concentration and adiposity, body fat distribution, lipid profile, renal profile, liver enzymes, Cardio vascular parameters, histopathology of Liver, in high fructose diet fed Sprague-dawley rats. It was concluded that telmisartan and rutin are effective in treating metabolic dysfunction and alcohol induced liver toxicity Further studies are needed to explore the underlying mechanisms. Keywords: High fructose diet, Termisartan, Rutin, Alcohol. INTRODUCTION Metabolic syndrome is a set of risk factors that includes: abdominal obesity, a decreased ability to process glucose (increased blood glucose and/or insulin resistance), dyslipdemia, and hypertension. Metabolic syndrome is thought to be caused by adipose tissue dysfunction and insulin resistance. Dysfunctional adipose tissue also plays an important role in the pathogenesis of obesity-related insulin resistance 1. Both adipose cell enlargement and infiltration of macrophages into adipose tissue result in the release of proinflammatory cytokines and promote insulin resistance. Insulin resistance appears to be the primary mediator of metabolic syndrome. Insulin promotes glucose uptake in muscle, fat, and liver cells, and can influence lipolysis and production of glucose by hepatocytes 2. Additional contributors to insulin resistance include abnormalities in insulin secretion and insulin receptor signaling, impaired glucose disposal, and pro-inflammatory cytokines. These abnormalities, in turn, may result from obesity with related increases in free fatty acid levels and changes in insulin distribution (insulin accumulates in fat). To mimic this non genetic pre diabetic insulin resistance condition in rats, we are feeding the rats with a high calorie food in the form of high fructose diet (HFD) 3. Development of vascular dysfunction was reported in HFD fed insulin resistant animals, further PPAR- γ agonists such as telmisartan had shown promising improvement in the metabolic abnormalities associated with insulin resistant. In addition to its effect on metabolic parameters the vascular protective nature has been demonstrated in several experiments, these agents performing the vascular protection through anti oxidative, anti-inflammatory and anti proliferative mechanisms. But the conventional TZDs are well known for their side effects such as weight gain and heart failure; hence these compounds are not advisable to obese patients who are already at great risk for CVDs. Therefore there is a tremendous need to develop a drug to treat metabolic syndrome and associated CVDs and it should be free of above mentioned side effects 4. On the other side, RAS has identified as a key player in the development of CVDs associated with diabetes, most of the deleterious effects of RAS are mediated through AT 1 receptor stimulation by Ang II. Blockade of RAS is found to be beneficial in these situations, but multidimensional therapeutic interventions are required to combat coexisting diabetes and CVDs, till now there is no single drug available to treat the above condition, so there is a need of combination regimen to treat metabolic and cardiovascular disorders effectively 5. Fortunately the serendipitous discovery of some of the ARBs for their additional PPAR- γ agonistic property has given the idea for the development of new and evaluation of existing drugs in metabolic syndrome. This discovery raised the hope for the development of new dual pharmacophores in future. Telmisartan is reported to be a dual pharmacophore (ARB/ PPAR- γ) 6. Some studies have demonstrated the beneficial effects of telmisartan on metabolic profile in insulin resistant and diabetic conditions, but there are no systematic studies carried out to evaluate the beneficial role of these dual pharmacophore on vascular protection in metabolic syndrome. In this present work we studied the effect of telmisartan on both vascular and metabolic parameters. Administration of alcohol at this condition further increases the risk. Combination of HFD and alcohol may increase reactive oxygen species this will damage the liver 7. Some studies shows that rutin a Flavonoid glycoside having powerful anti oxidant as well as powerful anti inflammatory property in the present work we studied the effect of rutin on vascular and metabolic parameters 8. Page 57

2 MATERIALS AND METHODS Animals Male Sprague Dawley (SD) rats of g body weight were procured from the national institute of nutrition, Hyderabad, India. The animals were maintained under controlled room Temperature (22 ± 2 C) and humidity (55 ± 5 %) with a 12-h light / dark cycle. Animals were housed in three animals per cage and allowed to food and water ad libitum 9. Rats were grouped and fed with either standard chow diet (NPD) or high fructose diet (HFD). All experiments and protocols described in present study were approved by the Institutional Animal Ethical Committee (IAEC) of KLR Pharmacy College, Paloncha, Khammam (No.1516/PO/a/11/CPCSEA). Chemicals Telmisartan and Rutin were procured from sigma chemicals, St Louis, USA. Alcohol was purchased from neon labs, Mumbai, India. All other chemicals and reagents were used of analytical grade. Dose Selection In the present study treatment control groups 10 % HFD (high fructose diet), alcohol at a dose of (20 % v/v) and the treatment groups telmisartan dose (5 mg/kg), rutin (50 mg/kg) were administered by per oral route in morning throughout the study period. Experimental Design High Fructose Diet Induced Metabolic Dysfunction: Experimental study was carried out using adult Male Sprague Dawley rats weighing between g. The animals were housed in polypropylene cages of dimension The cages were maintained under clean and hygienic conditions 10. Animals were acclimatized to light and temperature with a 12 h - 12 h dark-light cycle; the rats were fed with commercial pelleted rat feed and water ad libitum. Total 60 adult male rats were selected for the study and divided into 10 groups each containing 6 rats. Group 1 is the Control (fed with normal pellets chows). Group 2 rats have received HFD (10 % v/v.p.o.) with normal pellets). Group 3 animals have received Alcohol (20 % v/v p.o) with normal pellets. Group 4 animals were fed on HFD (10 % v/v) + Alcohol (20 % v/v) with normal pellets. Group 5 animals received HFD + telmisartan (5 mg/kg) p.o with normal pellets. Group 6 animals received Alcohol + telmisartan (5 mg/kg) p.o with normal pellets. Group 7 animals received HFD + alcohol + telmisartan (5 mg/kg) p.o with normal pellets. Group 8 animals received HFD + rutin (50 mg/kg) p.o with normal pellets. Group 9 animals received Alcohol + rutin (50 mg/kg) p.o with normal pellets. Group 9 animals received HFD + alcohol + rutin (50 mg/kg) p.o with normal pellets. Composition of the Atherogenic Diet: 1 % Cholesterol (Sd fine-chem limited), 0.5 % Cholic acid (LOBA CHEMIE), 5 % Lard oil (Open Market). These diets were provided in addition to normal pellet chow 11. Treatment Protocol: Induction of metabolic syndrome in the experimental animals was carried out by feeding the animals with the high fructose diet. Induction of liver toxicity in the experimental animals was carried out by feeding the animals with the alcohol. Telmisartan was administered orally in a dose of 5 mg/kg, p.o. daily for the entire study period. Rutin was administered orally in a dose of 50 mg/kg, p.o. daily for the entire study period. 24 h before the sacrifice of the study animals, they were kept on fast but they had access to water. The blood samples were collected in eppendroffs tubes by puncturing the retro orbital plexus for biochemical estimation. Then experimental animals were sacrificed and the liver was collected and was kept in 15 % V/V formalin solution for histopathological examination. Statistical Analysis All results are expressed as mean ± SEM. Statistical analysis was performed using the Graph pad prism 5, Graph pad software. One-way ANOVA followed by Dunnett s test was performed. Histopathological Examination The liver was fixed in 10 % formalin and embedded in paraffin. Five-micron thick sections were prepared and stained with hematoxylin and eosin (H and E) 12. The tissue sections were evaluated under light microscopy by a blinded pathologist. RESULTS AND DISCUSSION Initially we have validated the pre diabetic metabolic syndrome rat model by feeding high fructose diet to the male Sprague Dawley rats. The metabolic syndrome rats showed a significant increase in the activity of serum LDL VLDL levels and Treated rats showed significant results. It was observed from the Tables 1-3. The metabolic syndrome rats showed a significant increase in the activity of serum LDL VLDL levels. The increased blood levels of total cholesterol, LDL, VLDL as well as lowered levels of HDL in high fructose diet rat have been identified in the development of hypercholestremia, which is one of the risk factors for CAD. Administration of telmisartan and rutin produces a significant decrease in the activity of LDL VLDL Our findings showed that obese rats treated with the telmisartan and rutin exhibited significant decreases in LDL, VLDL activity from Table 3. The telmisartan and rutin could prevent the development of atherosclerosis through regulating vascular inflammatory processes in rats fed with a high fructose diet. The current data showed a significant increase in the activity of enzymes AST and ALT in the metabolic syndrome rats compared with control rats from Table 3. Liver is bombarded by the free fatty acids (FFA) that pour out of the adipose tissue into the portal blood. This can directly cause inflammation within the liver cells, which then release further pro-inflammatory cytokines, leading to more hepatocyte injury and affecting the integrity of liver cells. The present results demonstrate that the telmisartan and rutin showed a significant decrease in the activity of both AST and ALT from Table 3 and showing a hepatic protective action. The results obtained showed significant correlation between adiponectemia and adiposity, body fat distribution, in atherogenic diet fed obese animals. The preliminary investigation of effects of telmisartan and rutin showed to improve the overall picture of metabolism especially the fatty acid metabolism. The plasma adiponectin levels were found to be significantly decreased in HFD group (p < 0.001), and a significant increase was observed in HFD + Telmisartan (5 mg/kg) groups (p < 0.001), Alcohol + Telmisartan (5 mg/kg) (obese + treated) group (p < 0.01), HFD + Rutin (50 mg/kg) group (p < 0.01), Alcohol + Rutin (50 mg/kg) group (p < 0.01), when compared to control group. Page 58

Table 1: Effect of Telmisartan and Rutin on Body Weight and Glucose Levels in HFD Plus Alcohol Induced Metabolic Dysfunction in Rats Body weight Glucose Levels (Mean ±SEM) Control 181.0 ± 0.91 91.

15 ± 0.85 b*** 112.83 ± 2.08 b*** Alcohol (20 %v/v) + Telmisartan (5 mg/kg) 213.0 ± 1.29 b*** 114.0 ± 2.43 c*** HFD + Alcohol (20 %v/v) + Telmisartan (5 mg/kg) 215.5 ± 0.64 b*** 131.5 ± 2.

3 Table 1: Effect of Telmisartan and Rutin on Body Weight and Glucose Levels in HFD Plus Alcohol Induced Metabolic Dysfunction in Rats Body weight Glucose Levels (Mean ±SEM) Control ± ± 1.35 HFD ± 3.32 a*** ± 1.47 a*** Alcohol (20 %V/V) ± 0.91 a*** ± 2.58 a*** HFD + Alcohol (20 %V/V) ± 1.82 a*** ± 0.96 a*** HFD + Telmisartan (5 mg/kg) ± 0.85 b*** ± 2.08 b*** Alcohol (20 %v/v) + Telmisartan (5 mg/kg) ± 1.29 b*** ± 2.43 c*** HFD + Alcohol (20 %v/v) + Telmisartan (5 mg/kg) ± 0.64 b*** ± 2.17 d*** HFD + Rutin (50 mg/kg) ± 1.47 b*** ± 2.86 b*** Alcohol (20 %v/v) + Rutin (50 mg/kg) ± 1.54 b*** ± 1.54 c*** HFD + Alcohol (20 %v/v)+ Rutin (50 mg/kg) ± 1.04 b*** ± 1.96 d*** Table 2: Effect of Telmisartan and Rutin on Total Cholesterol, HDL and LDL Levels in HFD plus Alcohol Induced Metabolic Dysfunction in Rats Total Cholesterol Levels (Mean ±SEM) HDL Levels LDL Levels Control ± ± ± 1.17 HFD ± 1.60 a*** ± 0.88 a*** ± 1.85 a*** Alcohol (20 %V/V) ± 1.23 a*** ± 0.88 a*** ± 0.57 a*** HFD + Alcohol (20 %V/V) ± 1.24 a*** ± 0.76 a*** ± 0.76 a*** HFD + Telmisartan (5 mg/kg) ± 0.89 b*** 36.16± 1.10 b*** ± 0.74 b*** Alcohol (20 %v/v) + Telmisartan (5 mg/kg) ± 1.42 c*** ± 0.86 c*** ± 0.71 c*** HFD + Alcohol (20 %v/v) + Telmisartan (5 mg/kg) ± 1.66 d*** ± 0.86 d*** ± 0.84 d*** HFD + Rutin (50 mg/kg) ±1.54 b*** ± 0.89 b*** ± 0.60 b*** Alcohol (20 %v/v) + Rutin (50 mg/kg) ± 1.29 c*** ± 1.26 c*** ± 0.51 c*** HFD + Alcohol (20 %v/v) + Rutin (50 mg/kg) ± 1.25 d*** ± 0.79 d*** ± 0.70 d*** Table 3: Effect of Telmisartan and Rutin on Liver Weight, SGPT and SGOT Levels in HFD plus Alcohol Induced Metabolic Dysfunction in Rats Liver Weight ALT (SGOT) Levels AST (SGPT) Levels Control 2.57 ± ± ± 0.19 HFD 3.28 ± 0.12 a*** ± 0.45 a*** ± 1.06 a*** Alcohol (20 %V/V) 3.18 ± 0.26 a*** ± 0.76 a*** ± 0.60 a*** HFD + Alcohol (20 %V/V) 3.92 ± 0.17 a*** ± 1.25 a*** ± 0.67 a*** HFD + Telmisartan (5 mg/kg) 2.90 ± 0.08 b*** ± 1.53 b*** ± 2.16 b*** Alcohol (20 %v/v) + Telmisartan (5 mg/kg) 2.92 ± 0.09 c** ± 0.89 c*** ± 0.54 c*** HFD + Alcohol (20 %v/v) + Telmisartan (5 mg/kg) 2.79 ± 0.10 d*** ± 0.77 d*** ± 0.70 d*** HFD + Rutin (50 mg/kg) 2.83 ± 0.06 b** ± 0.52 b*** ± 0.58 b*** Alcohol (20 %v/v) + Rutin (50 mg/kg) 2.87 ± 0.02 c*** ± 0.26 c*** ± 0.07 c*** HFD + Alcohol (20 %v/v) + Rutin (50 mg/kg) 2.80 ± 0.06 d*** ± 1.58 d*** ± 0.74 d*** (Figure 1a, H and E, x 400) (Figure 1b, H and E, x 400) Figure 1: High Fructose Diet Section shows liver parenchyma with partially effaced architecture Page 59

. (Figure 2a, H and E, X 400) (Figure 2b, H and E, x 400) Figure 2: Alcohol + Telmisartan [5 mg/kg]: Section studied shows liver parenchyma with intact architecture (Figure 3a, H and E, x 400)

Section studied shows liver parenchyma with intact architecture (Figure 4a, H and E, x 400) (Figure 4b, H and E, x 400) Figure 4: Control: Section studied shows liver parenchyma with intact

The regenerative changes were observed in the group of animals treated with the telmisartan and rutin the tissue elements lost due to the induction of disease condition namely metabolic syndrome

High Fructose Diet Section studied shows liver parenchyma with partially effaced architecture.

Most of the central veins (Long-arrow, Figure 1) and sinusoids are dilated and congested (Short-arrow, Figure 2).

Some of the hepatocytes show regenerative changes (Arrow, Figure 1), while few show regenerative changes (Arrow, Figure 1). Most of the central veins are dilated and congested (Arrow, Figure 2).

4 . (Figure 2a, H and E, X 400) (Figure 2b, H and E, x 400) Figure 2: Alcohol + Telmisartan [5 mg/kg]: Section studied shows liver parenchyma with intact architecture (Figure 3a, H and E, x 400) (Figure 3b, H and E, x 400) Figure 3: Alcohol + Rutin [50 mg/kg]. Section studied shows liver parenchyma with intact architecture (Figure 4a, H and E, x 400) (Figure 4b, H and E, x 400) Figure 4: Control: Section studied shows liver parenchyma with intact architecture Histopathology Report Histopathological studies of Liver were conducted. The results found are highly encouraging. The regenerative changes were observed in the group of animals treated with the telmisartan and rutin the tissue elements lost due to the induction of disease condition namely metabolic syndrome and alcohol induced liver toxicity, the cardiovascular comorbidity were regenerated and restored in the treated animals. High Fructose Diet Section studied shows liver parenchyma with partially effaced architecture. Most of the hepatocytes show apoptotic changes (Short-arrow, Figure 1), while some show cytoplasmic vacuolations (Long-arrow, Figure 2). Most of the central veins (Long-arrow, Figure 1) and sinusoids are dilated and congested (Short-arrow, Figure 2). Alcohol + Telmisartan [5 mg/kg]: Section studied shows liver parenchyma with intact architecture. Some of the hepatocytes show regenerative changes (Arrow, Figure 1), while few show regenerative changes (Arrow, Figure 1). Most of the central veins are dilated and congested (Arrow, Figure 2). There are seen scattered mononuclear inflammatory infiltrations within parenchyma. Alcohol + Telmisartan [5 mg/kg]: Section studied shows liver parenchyma with intact architecture. Some of the hepatocytes show regenerative changes (Arrow, Figure 1), while few show regenerative changes (Arrow, Figure 1). Most of the central veins are dilated and congested (Arrow, Figure 2). There are seen scattered mononuclear inflammatory infiltrations within parenchyma. Alcohol + Rutin [50 mg/kg]. Section studied shows liver parenchyma with intact architecture. Few of the central veins (Short-Arrow, Figure 1) and sinusoids show congestion (Long-Arrow, Figure 1). Some of the hepatocytes show regenerative changes (Arrow, Figure 2). There are seen few mononuclear inflammatory infiltration within parenchyma. Control Section studied Page 60

5 shows liver parenchyma with intact architecture. Most of the perivenular hepatocytes and periportal hepatocytes appear normal. Within the hepatic parenchyma are seen few scattered mononuclear inflammatory cells [Figure 2, arrow]. The study showed that telmisartan and rutin significantly counters the high fructose diet and alcohol induced cardiovascular properties and improves the lipid profile in the experimental animals. Adiponectin is a protein hormone that modulates a number of metabolic processes, including glucose regulation and fatty acid catabolism. In the present study, we examined the effect telmisartan and rutin and the relationship between the plasma adiponectin concentration and adiposity, body fat distribution, lipid profile, renal profile, liver enzymes, CVS parameters, histopathology of Liver, in high fructose diet fed Spraguedowley rats. CONCLUSION The results obtained in our study of weight gain/loss, weight of liver, fat distribution, lipid profile, liver enzymes, glucose, histopathology and the plasma adiponectin concentration, in the treated and untreated experimental animals indicate that properties of telmisartan and rutin improve the overall health. However, further extensive investigation is needed to understand the overall mechanisms of improving overall metabolic changes. Thus telmisartan and rutin are effective in treating metabolic dysfunction and alcohol induced liver toxicity Further studies are needed to explore the underlying mechanisms. ACKNOWLEDGEMENTS The Authors are thankful to Mr. K. Lakshma Reddy, Chairman-KLR Institutes, Paloncha, Andhrapradesh, India for providing necessary facilities and Dr. Nagarjuna Reddy, Principal, KLR College of Pharmacy, Paloncha, Andhrapradesh, India for his support to carry out this Research Project. REFERENCES 1. Sobel BE, Schneider DJ. Cardiovascular complications in diabetes mellitus. Current Opinion in Pharmacology 2005; 5: doi.org/ /j.coph PMid: Reimann M, Bonifacio E, Solimena M, Schwarz PEH, Ludwig B, Hanefeld M, Bornstein SR. An update on preventive and regenerative therapies in diabetes mellitus. Pharmacology and Therapeutics 2009; 121: PMid: Virally M, Blickl JF, Girard J, Halimi S, Simon D, Guillausseau PJ. Type 2 diabetes mellitus:epidemiology, pathophysiology, unmet needs and therapeutical perspectives. Diabetes and Metabolism 2007; 33: PMid: Dapagliflozin trial results indicate improvement in key glycemic measures in treatment-naive type 2 diabetes.the Medical News; p Palumbo PJ. Metformin: Effects on Cardiovascular Risk Factors in Patients with Non insulin Dependent Diabetes Mellitus. Journal of Diabetes and Its Complications 1998; 12: Tahrani AA, Piya MK, Barnett AH. Saxagliptin: a new DPP4 inhibitor for the treatment of type 2 diabetes mellitus. Advanced Therapeutics 2009; 26(3): PMid: Neumiller JJ, White JR and Campbell RK. Sodium glucose transport inhibitors progress and therapeutic potential in type 2 diabetes mellitus. Drugs 2010; 70(4): PMid: Bloomgarden ZT. Diabetes treatment. Diabetes Care 2009; 32(3): PMid: PMCid:PMC Shih Li S. Sodium Glucose transporter. Formos J Endocrin Metab 2009; 1(1): Drug Report: Dapagliflozin. Thomsan Pharma Reuters; Tahrani AA, Piya MK, Barnett AH. Glycaemic control in type 2 diabetes: targets and new therapies. Pharmacology and Therapeutics 2010; 125: PMid: Cite this article as: N. Lal Mahammed, P. Sireesha, E. Supraja, B. Pooja. Effect of Telmisartan and Rutin in alcohol plus high fructose diet induced metabolic dysfunction in rats. Int. Res. J. Pharm. 2013; 4(12): Source of support: Nil, Conflict of interest: None Declared Page 61

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